Specialty: Respiratory Medicine

Transcription

1 Deanery sponsoring programme: Postgraduate Dean: Responsible Associate Dean/GP Director: North of Scotland Professor Gillian Needham Dr Ken McHardy Programme Type - Deanery-based or National: Deanery Specialty or Sub-specialty: Specialty Date of GMC recent approval: August 2010 Associated Royal College / Faculty The Joint Royal Colleges of Physicians Training Board (JRCPTB) Web address Curriculum and Associated Assessment System Date programme information last updated August 2010 Recognised Programme Locations and Environments This programme involves placements in some or all of these Health Boards and hospitals: North of Scotland placements in Aberdeen hospitals and Inverness NHS Grampian Aberdeen Royal Infirmary, Aberdeen NHS Highland Raigmore Hospital, Inverness Programme Director Dr Gordon Christie Contact Dr Gordon Christie Respiratory Department Wards 1 & 2 Aberdeen Royal Infirmary Foresterhill Road Aberdeen AB24 2ZN Tel: /558809; Bleep gordon.christie@nhs.net Programme Description Why choose this programme? The Respiratory training programme in the North of Scotland offers comprehensive clinical training in a very busy but highly efficient & highly supportive atmosphere, based in Aberdeen Royal Infirmary (ARI) and Raigmore Hospital, Inverness. We value our trainees & have very high expectations of them but recognise that we need to work hard to provide high quality training. With a complement of around 900 beds, ARI is a major tertiary referral centre for the North and North East of Scotland, Orkney & Shetland and provides a complete range of medical and surgical specialities, described below. An Emergency Care Centre is currently being built, and will open in The Respiratory Unit will move into the Emergency Care Centre adjacent to the new Medical HDU. The medical school and Institute of Medical Science are also on site and trainees will have the opportunity to pursue teaching and research interests. Training also occurs, typically for 2 years, in Inverness at Raigmore Hospital, which is a large

2 district general hospital, with an established and well respected 30 bed Respiratory Unit. Specialty Information ABERDEEN ROYAL INFIRMARY Facilities and training opportunities Our unit provides comprehensive facilities for patients with Respiratory disorders in the Grampian region and also provides a service for those from the islands of Orkney and Shetland (total population approximately 570,000, 610,000 including Orkney & Shetland). Currently we have 8 Respiratory consultants in Aberdeen and 4 in Inverness. In patient activity We have 30 in-patient beds, admitting approximately 2,500 patients annually. Patients are admitted either directly via their GP, following Chest Clinic assessment, following assessment by our triage team or following early transfer from the Acute Medical Assessment Unit. We have a 24-hour physiotherapy led acute non-invasive ventilation service treating approximately 180 patients per year, with both bi-level and continuous pressure support. We also have thoracic ultrasound and transcutaneous CO2 monitoring. We have extensive sub-speciality nursing support, detailed below. Out patient activity We have one of the largest Chest Clinics in the UK, with approximately 10,000 attendances each year of which over 2,500 are new outpatient referrals. Within the Chest Clinic are more specialised weekly clinics in: Adult Cystic Fibrosis. Sleep Medicine Interstitial Lung Disease Tuberculosis Difficult Asthma We also have regular all-day peripheral clinics held at least twice each month at local hospitals in Peterhead, Banff and Elgin. The possibility of establishing a further peripheral clinic in Huntly is being explored. Specialist services Lung Cancer There are approximately 350 new diagnoses of lung cancer in Grampian each year. There is a well-established local multidisciplinary team including respiratory medicine, oncology, radiotherapy, thoracic surgery, pathology, radiology and cytology. The unit has consistently achieved targets for referral over many years, and a higher proportion of Grampian patients receive active treatment for lung cancer than elsewhere in Scotland. Patients are regularly recruited into multicentre trials. Lung cancer survival in Grampian exceeds the Scottish average. Bronchoscopy There are 2 weekly Bronchoscopy sessions (Tuesday pm with facilities for GA and Thursday pm under LA) with modern facilities including endobronchial ultrasound. Approximately 600 procedures are performed each year. Interstitial Lung Diseases Three consultants (Dr Dempsey, Fitch and Christie) run ILD clinics each week, and we hold a monthly

3 multidisciplinary ILD conference to discuss difficult cases. We receive input form the pathology team, including Prof Keith Kerr, who is on the UK ILD panel. There are 2 consultant radiologists with a particular interest in thoracic imaging and 2 thoracic surgeons on site. We are currently involved in ongoing multicentre ILD trials, have a research nurse and have recently published in this field. We also have a physiotherapy led ambulatory oxygen assessment service for our ILD patients. Difficult asthma Two consultants (Dr Douglas and Currie) run a Difficult Asthma clinic each month. This new clinic aims to review patients on continuous steroid tablets and/or those with multiple admissions to look in detail at adherence with therapy, avoidable triggers, complications including bronchiectasis etc Exhaled NO and serum prednisolone levels are available and mannitol challenge testing is being developed. Tuberculosis In Grampian there are approximately 50 new cases of TB every year and in addition there are approximately 25 patients found to have environmental mycobacterial infection. A monthly TB clinic is run by Dr Douglas and the TB control Sister (Susan Duthie). Additional clinics are occasionally held to review patients with suspected latent TB found through immigrant screening. Pulmonary function The Pulmonary Function laboratory within ARI provides a range of physiological services, including plethysmography (2 body boxes). Thoracic surgery There is a busy Cardiothoracic Surgical Unit within ARI staffed by 4 Consultants of whom 2 undertake Thoracic Surgery (Mr Hardy Remmen and Mr Keith Buchan). We have rapid access to video-assisted thoracic lung surgical procedures and also rigid bronchoscopy Pulmonary vascular disease The Scottish Pulmonary Vascular Disease Unit now visit 3 monthly intervals and provide a satellite clinic for patients with pulmonary hypertension, at which our trainees can participate. Radiology We have a full range of imaging available including conventional CT, spiral CT, MR, isotope scanning and on-site PET. Two of our radiologists (Dr Gomersall and Dr Denison) have a major interest in Thoracic Imaging, including stent placement. ITU support We have a large ITU with 19 beds, with a full range of services, most recently including extracorporeal membrane oxygenation (ECMO). Our senior trainees rotate through ITU for a minimum of 3 months and the option of further training in ITU is possible. Sleep Service There is a well established Sleep Service run by Dr Fitch. Currently there are over 1000 patients established on CPAP, and the sleep clinic receives upwards of 500 new referrals per year, with specialist nurse support. Patients needing BiPAP home ventilatory support for kyphoscoliosis, neuromuscular disease etc (currently over 60) are also

4 seen through this service. Early Supported Discharge We have an early supported Respiratory discharge service for the population within approximately 20 miles of Aberdeen city (approximately 300,000 people), which accepts around 350 to 400 referrals per year. Community pulmonary rehabilitation is well established in Aberdeenshire, and plans exist to expand the existing hospital-based system within Aberdeen city to provide comprehensive community-based pulmonary rehabilitation. There is an active Respiratory Managed Clinical Network exploring a variety of novel forms of service provision for chronic lung disease. Hyperbaric Medicine Our senior trainees have the opportunity to receive training in Hyperbaric Medicine, and, if they wish, gain experience in this field. We have a clinical recompression facility at ARI for the emergency treatment of diving related illness, carbon monoxide poisoning and other indications. 4 Respiratory consultants contribute to the national Hyperbaric Medicine service based in Aberdeen. Specialist Nurse / Physiotherapy support We have Specialist Nurses for Lung Cancer (1), Lung Cancer investigation (2), Adult Cystic Fibrosis (1.8), Tuberculosis Control (1.5), Sleep Medicine (2.5), Respiratory triage (2) and an outpatient Nebuliser Service (1). In addition there is an Early Supported Respiratory Discharge Service for patients admitted with chronic lung disorders staffed by 5 wte Respiratory trained nurses. We also have a Hospital at Night service. Specialist respiratory physiotherapist support is provided by a team normally including one clinical specialist, one band 7 physio based within the unit and two rotating band 6 physios. In addition the cystic fibrosis team is supported by a further 1.2 specialist physiotherapy posts. Teaching & training Multi-disciplinary meetings Weekly Departmental meetings are held (Thursday lunchtimes), covering the full range of Respiratory diseases. We also hold sub-speciality meetings in lung cancer, interstitial lung disease, cystic fibrosis, and thoracic pathology. Our medical school is on site and weekly Grand Rounds are held in a state of the art teaching facility every Wednesday lunchtime. Regional and National training programme We have a Structured Training Programme, held regionally with trainees from Dundee. A National Programme is starting in 2010 and will supplement this. Feedback thus far has been excellent and we regularly invite guest speakers and active participation from trainees themselves. Teaching experience Involvement in undergraduate and junior postgraduate education is expected, and strongly encouraged. The Respiratory Unit has played a major role in organising the IMPACT course in Aberdeen (usually 4 courses/ year) over the last 5 years. The majority of final year respiratory trainees have had the opportunity to act as course director over recent years. Research / audit The Respiratory Unit has a considerable reputation in clinical research currently led by Professor Graham Devereux.

5 The research program is expanding & we anticipate further opportunities for Out of Program Research in the next few years. Our trainees have the opportunity to take time out of programme for research, opportunities including: Studies into the role of eosinophils and their products in the pathogenesis of Asthma Studies into the early life origins of Asthma and Allergy The natural history of wheezing syndromes: particularly factors affecting decline in lung function including perinatal factors, childhood diagnostic category and diet Studies into outcome measures for Asthma particularly quality of life Major involvement in National / MRC etc studies into the chemotherapy and other management of Lung Cancer Interstitial lung disease (currently we are the only Scottish centre recruiting into multicentre ILD trials) Developmental research into whether the plethysmogram from a pulse oximeter can be used to record respiratory rate Studies into the value of inhaled mannitol in the management of patients with bronchiectasis Clinical trials of newer biological agents in the management of severe persistent asthma. How to apply Deanery Administrative Contacts Name Address Tel Dianne Morrison NHS Education, Forest Grove Aberdeen, Aberdeen, AB25 2ZP Dianne.Morrison@nes.scot.nhs.uk Quality of Training GMC Trainee Survey Information (2010)